| NPI | 1841292802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 2017) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: CT 2017) |
| Enumeration Date | 2005-06-02 |
| Last Update Date | 2013-01-10 |